Leonard Rubenstein

With the Israeli government recently stating that, according to its own calculations, over 65% of deaths from Israeli military operations in Gaza were civilians, time and investigations will tell whether any of that military conduct violated the Geneva Conventions. Another question, however, demands critical attention as well: Whether Israel is promoting an interpretation of international humanitarian law that undermines the Conventions’ values and subverts their rules. That might explain some of the outcomes we are seeing on the ground. Despite couching its explanations in humanitarian law’s language of proportionality and minimization of harm, Israel has asserted a theory of justifiable conduct in war that, contrary to this body of law, elevates claims of military necessity in achieving the war’s aims over protection of civilians, particularly in a just war. The theory harks back to the influential nineteenth-century intellectual and military theorist Francis Lieber, who advanced it around the very time the first Geneva Convention was being developed. It is important to look back at that long-rejected concept of legitimate warfare and to closely trace what Israeli officials have propounded in the current conflict.

Although governments have continually declared that attacks on health care are unacceptable, their conduct shows instead that the attacks have become accepted. Today our Chair Len Rubenstein will speak at a special session of the UN Security Council to press governments to end their passivity and act to protect health workers and health care.

This article examines attacks on health care facilities in conflicts in six middle- to high- income countries that have occurred over the past three decades to try and determine if attacks have become more common, and to assess the different methods used to collect data on attacks. The six conflicts reviewed are Yemen (2015-Present), Syria (2011- Present), Iraq (2003–2011), Chechnya (1999–2000), Kosovo (1998–1999), and Bosnia and Herzegovina (1992–1995).

The WHO's commitment to collecting and analyzing data on attacks against health care is a sign of great progress toward holding the perpetrators of the violence accountable. But it is important that this momentum is continued to turn that action into change. In this article Rubenstein discusses the global actions that were taken leading up to the WHO commitment, what are some continuing barriers to accountability, and what are the next steps forward.

The conflicts and political crises in the Middle East have brought anguish, suffering, and severe declines in health to people throughout the region. The most catastrophic case by far is Syria, where more than a million people have experienced traumatic injuries, once-rare infectious diseases have returned, chronic disease goes untreated, and the health system has collapsed.